Donor hyperoxia is a novel risk factor for severe cardiac primary graft dysfunction

Area of Science:

• Cardiology
• Transplantation Medicine
• Critical Care

Background:

• Primary graft dysfunction (PGD) significantly contributes to early mortality after heart transplantation (HT).
• Donor-related risk factors for PGD remain incompletely understood.
• Donor management goals (DMGs) are critical care targets to optimize organ donors.

Purpose of the Study:

• To investigate the association between donor management goals (DMGs) and non-DMG parameters with the incidence of PGD post-HT.
• To identify specific donor characteristics that predict PGD development.

Main Methods:

• A retrospective analysis of 1,079 heart transplant recipients and their donors from two centers.
• PGD classification using modified ISHLT criteria.
• Multivariable modeling to identify independent risk factors for mild/moderate and severe PGD, with validation in a separate cohort of 4,010 donors.

Main Results:

• Mild/moderate PGD occurred in 15% and severe PGD in 6% of cases.
• Independent risk factors for severe PGD included donor age, donor fraction of inspired oxygen (FiO2), donor creatinine, and recipient factors like mechanical circulatory support.
• Donor age and FiO2 ≥ 40% were linked to increased 90-day mortality in a validation cohort.

Conclusions:

• Donor hyperoxia during heart recovery is identified as a novel risk factor for severe PGD and early post-transplant mortality.
• Findings suggest a need to limit excessive oxygen administration during donor management to mitigate PGD risk.